The politics of birth for the private midwife: A minefield from all directions

Being a private midwife can be a minefield, you never know what action will set of an explosion. We all know minefields are designed to destroy or disable.  This means you can have a varying degree of damage from slight, mediocre or catastrophic. Clearing minefields is a long, slow, time-consuming process, and there is no room for error, a bit like the life of a private midwife. There is no clear pathway every woman (case) presents another set of issues often a new battle or the same one revisited but it is the same minefield, you just pray that you don’t step on one and get damaged. You have to select your path carefully.

What is so infuriating; the level of bureaucracy that is required…. let me share a story or two…..you have a so called ‘low risk’ woman who wants a homebirth, she needs to be booked into hospital as a backup – this is required by several governing bodies, however the hospitals play ping pong with you – Hospital ‘A’ says ‘No’ this woman is ‘low risk’ she needs to birth in hospital ‘B’. Hospital ‘B’ tells you No ‘we don’t have the infrastructure’ to support a homebirth go to hospital ‘A’ and whilst this toing and froing is going on….. The woman is progressing through her pregnancy…..God help you if you have a problem…because everyone wants to pass the buck.... And in the meantime the Director General has resigned; there is a State election so the Minister of Health does nothing to assist you and no one in the dept. responds to your urgent requests for help……What is the private midwife to do? However if the private midwife is found to be lacking in some capacity the hammer falls very quickly and very hard…... There is just no equity in this at all…it seems that progress is ever so slow: however I am grateful for the help I do get from some corners  and without that this journey would not be worth it….  I am also thankful for the women for without them we would not be midwives and the breaking of new ground would not be possible.

On the other hand the minefield is the choice some women make: they choose for whatever reason to go outside any boundary the midwife has…outside of the scope of practice the midwife has, and each midwife has their own limits….. now the midwife can choose to accept that woman’s sole choice at her own personal risk… as there is nothing to protect that midwife when she works outside the boundary of the so called ‘low risk’, accept her documentation and sometimes that is not even enough – the woman is only wanting what she considers is in her best interest. However the midwife ends up having to defend themselves and this means $$$$$ in legal fees, even if the midwife did everything within her power. Who looks after the midwives best interest? Not the regulatory body, not the government and certainly not the AMA - The Midwife has too….because no one else will…. This is sad reflection of Midwifery practice in Australia – I for one am not prepared to risk my registration and pay out $$$$ in legal fees…. until the midwife is afforded protection as her counterparts in the UK and NZ the Australian private midwife is becoming are rare commodity and will become extinct.

I will end by saying I have had some wonderful experiences with women along this journey and every single one has taught me something about myself and pushed a boundary – I reflect on every experience and say ‘how can I make the next one better’. The major drawback is the political battle that each case brings in access to hospital, collaboration and the support required…. The burden of collaboration is tremendous….it is a one sided affair….every now and then you step on a landmine and you get damaged….. And you contemplate when will the damage be catastrophic and you pray it won’t be you and it won’t be today.

picture ref: http://www.smh.com.au/it-pro/innovation/blogs/smoke--mirrors/patent-battles-are-a-worry-for-developers-20120831-254fo.html

Hitting a Brick Wall

The National Health (Collaborative arrangements for Midwives) Determination of 2010 (This instrument determines the collaborative arrangements with the kinds of medical practitioners that an eligible midwife must participate in when providing midwifery treatment in order to satisfy the definition of 'authorised midwife'.). This Determination is clearly not working and needs to be amended or rescinded.

Obstetricians benefit from Eligible Midwives not being able to practice. Is it fair and equitable that this group can monopolise the market? Should the role of a collaborator be given to a Health Service or an independent body rather than a ‘named obstetrician’?

I am an Eligible Midwife and have a Medicare provider number. The government introduced the Maternity Reforms in 2010. With these reforms came the Determination for Midwives 2010. At the time of the Determination the then Minister of Health Nicola Roxon acknowledged that there were issues with the AMA but encouraged us (Midwives) to try and make the determination work. We are almost at the 2 year mark and this determination is not working. There is a multitude of evidence to show that obstetricians do not want to collaborate with midwives.
Here are some comments from Obstetricians

‘ I will do the birth you can do the rest’
‘I will not collaborate, I am happy with the status quo’
‘we do not support homebirth regardless of the risk, therefore I will not collaborate’
’I am very comfortable with the situation as it stands and I am not interested in supporting your model of care’

It seems that there is a condition with an offer to collaborate, which means that as a midwife I cannot work to my full potential. On the other hand, there are some private midwives so frustrated with the current political system, they have rescinded their registration and are working as birth attendants. These birth attendants support and assist women’s birth choices and are not responsible to any regulatory authority and are not insured. I wonder is this the answer?

This piece of legislation is a bad law it needs to be changed urgently to allow the Eligible Midwife to work as they were intended. That is to give women more choice, more continuity of midwifery care and for women to claim a Medicare rebate for those services.
Call or email your local member of Parliament and have you say: Ask for your right to see a Midwife and claim your Medicare rebate:

Collaborative Maternity Care Agreement - give your feedback

RANZCOG has developed a template for Collaborative Maternity Care Agreement between Eligible Midwife and Specialist Obstetrician or General Practice Obstetrician for use by Specialist Obstetricians or GP Obstetricians and Eligible Midwives.

It is very important to give your Feedback.

It is acknowledged that the template agreement will not be suitable for all settings and that not all Obstetricians will wish to enter into a collaborative arrangement, but all comments will be considered.RANZCOG

Please send feedback to Rupert Sherwood by email to ganderson@ranzcog.edu.au or by fax to +61 3 9419 0672.

Sending your response is important, this is how your voice and numbers count, please be proactive, read the document in its entirety... and give your feedback.

The art of listening and compromising with women

As a midwife the art of listening is imperative, not only listening but hearing what the woman is saying and wanting. This in its self comes with its own inherent problems because as a midwife you know what a woman wants, however this can be like walking a tightrope as a midwife is bound by rules and regulations, therefore it is about the language you use and the compromising you can implement to satisfy both the woman and the institution.

Language is commanding, it is all in the way it is presented; an example would be; you are having trouble monitoring(cardiotocograph (CTG) a woman and she is having a syntocinon (a synthetic form of a hormone oxytocin) infusion for an induction of labour (IOL). It is important to monitor the baby’s heart rate through this procedure as sometimes babies have a negative reaction to the drug and it needs to be stopped. The policy states that a woman having a syntocinon infusion needs to be on a CTG –however in this instance you cannot effectively monitor the woman. What is the midwife to do? The midwife reports to the doctor, the instructions are “the woman must be monitored, put a fetal scalp electrode on”. The procedure is explained to the woman, a small, tiny hook is put on the scalp of the baby, so we can monitor the baby – the woman flatly refuses this option, a definite “NO”. Next: the woman is told, “If you don’t have the scalp electrode and we cannot monitor you, our policy states we must do this. Therefore we will stop the drug and you can walk around for an hour, and if you don’t have contractions, we will start the drug again and you HAVE to have the scalp electrode attached”.

There is something profoundly wrong with this statement: the language is authoritarian, demanding, controlling, there is no compromising, no listening, no discussion, and it creates fear and rebellion and backs the woman into a corner. There has to be a better way of walking the tight rope without losing our balance and falling off. It may be sometimes possible to hold the monitor in place enabling a good CTG reading, thereby giving a good outcome, however I acknowledge that this can be difficult.

What do you do if a woman is refusing best practice, policy, or guidelines?

The answer, discuss the issues in a non-threatening way; give the reasons / evidence why it is important to do whatever it is you want; get the doctor to discuss the issues with the woman; clearly document all discussions and the reasons why the woman is refusing the treatment, however ensure that the woman understands the implications for her decision. It is also a good idea to read back your notes to the woman so that she clearly understands the implications of the discussions and it is how she sees the situation.

At the end of the day the decision will lie with the woman, if she is of sound mind, she is able to consent to treatment or equally refuse treatment. Part of our job is to give her balanced information to enable women to make an informed choice.

A policy is usually best practice and is to be followed. A guideline is as it suggests a guideline that usually outlines how the policy works; both are usually well referenced and evidenced based. In a legal proceeding the policy and guidelines of the time are called to guide the current practice at the time and the expected care to be provided.

Midwives are not and should not be expected to be doctor’s messengers; if doctors have these sorts of explicit instructions, they should be discussing this directly with the client/woman and not expecting midwives to pass on these instructions. The ANMC Competency standards, code of ethics and code of conduct all state that collaboration is essential with health professionals, this means discussing and sharing finding the middle ground, not just regurgitate doctors sentiments, doctors need to be building this relationship with the woman to also find a way to compromise. Midwives need to be mindful of the issue of “failing to obey a doctor’s order” this is a whole separate blog which I will be doing very soon. Working within a system you could face disciplinary action or be sacked for “Gross misconduct”…. Watch this space.

It must be remembered that the woman is the consumer, with her own freely chosen subjective preferences and desires. Doctors tend to practice paternalism – thinking that they know best. Paternalism in medicine is defined as acting for the welfare of the woman, often interfering with or disregarding the woman’s autonomy. Doctors need to find the middle ground.

Autonomy means ‘self-rule’, to act autonomously a woman needs liberty and independence from controlling influences, it is the right to hold your own views. As a midwife we walk a tightrope, balancing the woman’s needs, the requirements of the regulatory bodies and doctors recommendations…….the bottom line remains if a woman is of sound mind, well informed of her choices, she can refuse any treatment, however she needs to clearly articulate these choices together with the possible implications of her choice.

ref pic: http://lukespad.wordpress.com/

What’s in a name? Independent; Private Practice Midwife; Eligible Midwife

As I ponder how to advertise myself on the Internet I look at the possible variables and it comes down to “independent midwife” or “private practice midwife”, so let’s have a look at what difference a name makes:

What's in a name? That which we call a rose
By any other name would smell as sweet.

Shakespeare

By definition: dictionary.com “independent” –an independent person or thing.... not influenced or controlled by others in matters of opinion.... thinking or acting for oneself..... not subject to another’s authority or jurisdiction. – A free thinker.... not influenced by the thought or actions of others....

“private” – belonging to some particular person ( personal belonging)...pertaining to or affecting a particular person or a small group of persons; individual; personal; undertaken personally or individually without the presence of others; alone

“private practice” – independent and not as an employee; mainly pertaining to medicine;

Quote by George Bernard Shaw;

“He said that private practice in medicine ought to be put down by law. When I asked him why, he said that private doctors were ignorant licensed murders.”

Thesaurus.com: private practice by definition pertains to general medical care.... family practice and independent pertains to separate, liberated, free – alone, aloof, self governing

When I did a Google /Yahoo search of “independent midwife” the search generated pages of independent midwives Australia wide and internationally. The Google/Yahoo search with “Private Practice Midwives” generates equally a list of midwives however I have to say not as many as “independent” and more groups and associations....

It is interesting to note that the new Health Practitioner Regulation National Law Act 2010 refers to Private Practice Midwives and makes no mention of Independent Midwives: therefore I think there is a change in terminology .... moving towards private practice....

The upshot of this exercise highlighted that it doesn’t matter about the name women will find you whether you are called “independent or private midwife” so to throw the cat amongst the pigeons I am going to call myself “eligible private midwife”. My rationale for this is to focus on the legislative changes for midwives by highlighting the ‘eligible’ aspect therefore informing women of the ability to access Medicare rebates for midwifery care.

Remember; a midwife is a midwife is a midwife.... eligible, independent, private makes no real difference what matters is that you are a midwife.

Update for eligibility: still waiting!

Update on my application; I thought that I was very meticulous with my application but alas this was not the case; there is particular certified list of people that are required and I used a university academic which is not allowed;
the Certified List for AHPRA

Justice of the Peace, Bail Justice, Registrar or Deputy Registrar
 Commissioner for Declarations, Commissioner for Oaths, Commissioner for Affidavits (dependent on jurisdictions)
 Lawyer
 Accountant (member of the ICA, ASA, NIA or CPA)
 Registered members of the teaching profession
 Member of the police force
 Sheriff or Deputy Sheriff
 Public Notary
 Permanent staff member of AHPRA (I think it would be easier to take your certificates and copies into your local office to be certified)

Second I have written a two page letter to the Chair of the NMBA to ask why they are asking for the last 5yrs of experience (Statement of Service) instead of the 3 yrs required by the Registration Standards; I did send a letter from a manager who did deem me competent, however did not address the ANMC competencies, this was rejected for that reason. Finally why when we have successfully completed the Midwifery Practice Review (MPR) do you require a letter from a manger addressing the ANMC competencies? the goal posts keep moving;

Anyway I have resent my documents certified in the correct manner by a commissioner of declarations (a pharmacist) together with the letter asking for clarification and I have had no response to date. I have also forwarded this information onto the National ACM as evidence of issues relating to applying for eligibility; Really this process is cumbersome and unacceptable. I guess these issues will come up at the next Board meeting which I think is the 18th November; just as well I am not in a hurry, I feel for those midwives who do need this urgently;

How to apply for eligibility:

Today I sent in my application for an eligible midwife; like anything new the process is TIME consuming and there will be teething problems: I am hoping that I have completed everything as required; You do not need insurance to apply for eligibility; I have to say that I have had to send my application to Sydney as WA is not ready for this process: Here is my step by step process:

Step 1; Go to the AHPRA website and download on the first page fourth heading ‘Registration’ on drop down menu second one down click ‘Registration Process’; left hand side blue box; fifth one down; click common registration forms; Standard Format for Curriculum Vitae:print and save this form.

Step 2; While on the AHPRA website go to the Nursing and Midwifery site and download the Registration Standards for the Eligible Midwife third from the bottom; then on the left hand side fifth from the bottom click on forms; a third of the way down the page look for the heading Notations; click on Application for addition of notation as an eligible Midwife; print and save this form.

Step 3: Now you need to read and complete the forms; to make sure you meet these requirements before you apply; I have heard that there has been a problem with Independent Midwives who do not have Midwifery Managers.... so watch this space.... I would think that maybe one way around that might be that they could sign a statutory deceleration..... as this is legally binding.... but that will be for the Board to decide....lets hope they will work it out soon...

a. Current general registration as a midwife in Australia with no restrictions
on practice; You need to add your registration number with AHPRA:

b. Midwifery experience that constitutes the equivalent of 3 years full time
post initial registration as a midwife; Here you need a letter from your current Midwifery Manager outlining that you have worked across the continuum of midwifery care, antenatal, intrapartum and postnatal this letter is dated and signed;
You also need a statement of service; this is obtained from your HR department; I rang Health Corporate Network and gave them the years I work at the government institution and they sent me a very detailed statement of service;

c. Current competence to provide pregnancy, labour, birth and post natal
care to women and their infants; this can be proven by completing the Midwifery Practice Review (ACM) or some other accredited program(I don't know of any other one apart from the ACM one.

d. Successful completion of an approved professional practice review
program for midwives working across the continuum of midwifery care; as above

e. 20 additional hours per year of continuing professional development
relating to the continuum of midwifery care; if you have MidPLUS this will be easy you will just print out your summary; If you do not have MidPLUS you will have to produce evidence of attaining these points; copy your certificates and get them certified copies; I did not send any originals of certificates they were all certified copies.

f. Formal undertaking to complete within 18 months of recognition as a
eligible midwife; or the successful completion of: I wrote a letter using this wording saying that i will formerly undertake the course when it is ready.

i. An accredited and approved program of study determined by the
Board to develop midwives’ knowledge and skills in prescribing, or
ii. A program that is substantially equivalent to such an approved
program of study. As above.

Step 4: Follow the Standard format for CV; as it is slightly different to your current one; I just cut and pasted from my regular CV. One thing that is very different is the request for clinical / procedural skills - with this one I made up a table that gave the dates of my general clinical competences such as Obstetric emergencies; suturing, IV cannulation, neonatal resuscitation etc; and added certified copies of the certificates; You must make a declaration that your CV is true and correct and sign it. The CV has to be an original not a copy;

Step 5; add payment for your application; $90.00

Step 6: you also need someone to witness your signature when you have completed the application form

Step 7; Make sure you go through the checklist it is helpful to ensure you have completed everything; although the checklist does not ask for a letter from the manager and this is a requirement; Not sure why when you provide a statement of service;

Step 8; Take a copy of what you have prepared, I find this always good practice; double check it again and then post it to the AHPRA office in your capital city; if in WA post to Sydney NSW for the interim until the office is more settled in WA, as we only came on board middle of October.

I found this process tedious especially having to photocopy and get 16 copies certified of my qualifications and certificates; the CV was not problematic but had to be changed from my usual format; the letter from the employer was not difficult nor was obtaining the statement of service you just need to allow for the time to prepare for this application; I am hoping now that I have all this information that hospitals who require credentially will not want any more than this and when you have prepared it once it is then done.... life should be easy now....NEXT STEP MEDICARE PROVIDER NUMBER:

Lets hope I have not forgotten anything and have completed the application as required... will let you know how I get on......go on be daring take the step and apply for eligibility;

For more information visit the AHPRA website;

Ref: picture; http://www.clipartof.com/details/clipart/46255.html

The AMA has put out its Collaborative Arrangements:

There is much speculation surrounding this document; yes there are parts of it that make me cringe.... however it must be equally difficult for the AMA, not that any midwife wants to hear that;
Collaborative Arrangements what you need to know? the irony of this document has to make you laugh or cry:

"Working with other health professionals is an everyday feature of clinical practice for a modern medical practitioner. Effective teamwork can improve patient outcomes, create new opportunities for learning,and build a shared understanding of the skills that each person brings to the care of a patient."

Oh yes everyone is a patient even the well woman = this equals paternalism at its best; yes our medical colleagues are great at being paternalistic they feel they have the right to make that decision for the woman because they believe they know what is best; consequently, if the vulnerable woman is not able to make decisions or is not in a position to do so they are often coerced or made to feel fearful therefore making the decision the doctor wants.

“In a sense, this statutory requirement reflects the planned team care arrangements that have set parameters for collaboration in areas where doctors, midwives and nurses have always worked together - our hospitals.”

If we examine this statement they do say that it is “planned team care” and the word ‘collaboration’ means working together – not the GP/Obstetrician is in charge – it means a two way street. It will be interesting to see this work! because the doctors have the power and the money.... and automatically think they are in charge.

For me there are four main points that are important:

If we do not embrace these changes, then pressure will mount on the Government to relax the requirement for collaborative arrangements to be in place. This would risk fragmentation of care to the detriment of patients.

This is the most telling statement of all.... this means the AMA is seriously concerned that if they the doctors do not collaborate then changes will be made......this is in our favour.

Yes they are correct in saying that

“Some doctors will be challenged by the Government’s reforms, which will fund new models of patient care.”

This is clearly an understatement, we as midwives are certainly challenging them and if this collaborative framework does not work it will be changed; The doctors are back pedaling, they are fearful of losing money... so they are picking up stumps and are not going to play.

What should you do when a patient does not want to follow agreed clinical guidelines?

This may place you in a difficult situation.
The AMA believes that the best way of handling this is to ensure that your written collaborative arrangement clearly states that you will only provide care in accordance with accepted medical practice and within accepted clinical guidelines.
It should also clarify what will occur in circumstances where a patient declines to
follow these guidelines. If this occurs and you decide you cannot provide ongoing care for that patient, you will need to ensure that you advise the patient and the midwife/ nurse practitioner so that an alternative arrangement can be put in place by the nurse practitioner/midwife.
How you will address this issue if it occurs needs to be agreed prospectively in order to avoid a situation where you are forced to continue care because of a lack of
alternative arrangements.

This is nothing new, this is how the AMA works in every day practice, so this is no surprise....the only thing that is different is that they are blatant about and it is in writing.... there is no such thing as the clients right to choose the type of care they want or the right to refuse treatment.

Lastly I would like to be able to check the credentials of the doctors...what are their statistics, are they registered? how many women are not happy with their care etc? we should be able to check their register; that would be fair and just, equality.

Despite these issues I do think that we need to push forward, these are challenges put in our way and in time it will seem like a storm in a tea cup.

My vision is that all women will have the choice of continuity of midwifery care with a midwife and the right to claim a Medicare Rebate for fee for services;
Whilst I do not like the wording in this Determination I can see that this is still a historic time for midwifery....Opportunity is knocking..... walk through and make it work...if it doesn't you can always reject it.... but if we don't try we will never know it will always be a speculation

Eligible Midwife Australia.....this is what it looks like

The Nursing and Midwifery Board of Australia has submitted to the Ministerial Council for approval: the Registration Standard for Eligible Midwife and Registration for Endorsement for Scheduled Medicines for Eligible Midwives.

What does this mean for the average midwife in Australia?
Requirements
To be entitled to be identified as an eligible midwife, a midwife must be able to demonstrate, at a minimum, all the following:

Current general registration as a midwife in Australia with no restrictions on practice;

Midwifery experience that constitutes the equivalent of 3 years full time post initial registration as a midwife;

Current competence to provide pregnancy, labour, birth and post natal care to women and their infants;

Successful completion of an approved professional practice review program for midwives working across the continuum of midwifery care;

20 additional hours per year of continuing professional development relating to the continuum of midwifery care;

Formal undertaking to complete within 18 months of recognition as an eligible midwife; or the successful completion of:

an accredited and approved program of study determined by the Board to develop midwives’ knowledge and skills in prescribing, or

a program that is substantially equivalent to such an approved program of study, as determined by the Board.

My understanding of the above is that you can be deemed an eligible midwife and give the undertaking that you will complete within 18 months further study for prescribing and diagnostics.

Now we have to wait for the realise of the courses that we are to do...those from WA who have already completed the Eligible Midwife program which was four units...should get some RPL (recognition for prior learning).....
Until these units are established it seems that midwives are required yet again to jump through hoops to give continuity of care.....

the bottom line is that you will have to have three years experience across the continuum of midwifery before you can become an eligible midwife..... complete your Midwifery Practice Review and do further study.....oh and don't forget you need to be insured.....
We are the midwives paving the way for the future.... don't give up....lets beat the bastards and prove this can be done.....

The road to eligibility for the Midwife:

The question is how long will it take to become an eligible midwife? Gone are the days of qualifying as a midwife and practicing autonomously, now we have to jump through hoops. As you may be aware the laws in Australia are changing from the 1st July we go to National Registration, which in itself is not a bad thing. There will be four categories to the register for nurses and midwives: Registered Nurse (RN): Midwife: Non Practicing Midwife: Student nurse / midwife.

You can register as a RN & Midwife, if you are both you can choose to drop one or the other of your qualifications, that means you can register only as an RN or a Midwife should you choose to….. One thing I urge all RN / Midwives before dropping one or the other of your qualifications you will need to check your employment contract to ensure you have not signed a contract to be both…….
If you do maintain both professions you will have to complete the required ongoing professional development for both professions, and ensure you practice in both within a 5 year period otherwise you will not be able to register. There will be two registers, one for the RN and the Midwife.... there will also be a non-practicing Midwife register, and a student register for more information see the Nursing and Midwifery Board of Australia.
The other major change is that for midwives you need to declare your indemnity insurance, if you work for a hospital this will be easy you will need to contact your employer and ask them who you are insured with and provide this information to the Board.
The Australian College of Midwives is securing indemnity insurance for midwives, antenatal and postnatal care…..currently there will be no insurance for intrapartum (Homebirth).

One of the requirements for “the eligible” midwife will undoubtedly be Midwifery Practice Review (MPR), however the final requirements for eligibility have not been released yet. I have started this process because I want to be “an eligible midwife” even though I consider myself one….. I do not meet the government requirements. As from the 1st November midwives will be able to claim a Medicare number, (by the way midwife is not on the list until after the 1st November) now this is also no easy feat…… there are online courses that need to be completed first…..but you cannot do them until November…..do you feel like we are being screwed…. YES.

What I can do now is get my MPR review out the way…… what does this mean….. it means that you need to give yourself some time to complete this process and you need more than a few hours. I am traditionally one who keeps a portfolio, sets annual and 5 year plans as a rule, so none of this is new to me…. However if you have not done this before then allow yourself more time.

I have just completed the first stage of the MPR, that is; a synopsis of my CV, qualifications, current position, previous positions, professional development and key achievements; this takes about 2 pages. Followed by my Midwifery Philosophy half a page; clear current job description; you are half way now; next, reflect on your practice using the ANMC Competency Standards for the Midwife; you will use the four sub headings; Legal and Professional Practice; Midwifery Knowledge and Practice; Midwifery as Primary Health Care and finally; Reflective and Ethical Practice: you will use examples from your clinical practice to address each competency (we do it every day, we just do not necessarily recognize it or relate our work to our competences) this makes us write done what we do ; Now the bulk of the work is completed…all that is left is your short (12 mths) and long term goals (5yrs), you have to make your goals achievable…… that’s it all done… it took me all in all about 6-8 hours…. a few hours each day. Your synopsis should be submitted to the ACM fours week before your interview….. so that they can review your work to ensure it is all compete and meet the requirements…..then all that is left to do is the hour interview…..the interview will be with two reviewers a consumer and a midwife; Watch this space….
.

Having your say..... putting in submissions

The current state of play in WA is that Bill C has not gone through, what does that mean.... that means that WA will not be ready on the 1st of July for National Registration....we will probably be a month or two behind the rest of the country...Tasmania & SA are in the same boat as WA....

On 1 April 2010 The Australian Health Workforce Ministerial Council announced its approval of national health practitioner registration standards in regards to the National Registration and Accreditation Scheme for the Health Professions. The approval includes standards for scheduled medicines endorsements for suitably qualified and rural and isolated practice registered nurses (RNs). The proposed scheduled medicines endorsements for midwives, provided by the Nursing and Midwifery Board of Australia (the Board), has been delayed "pending the outcome of further priority discussions between the Board, and Commonwealth, State and Territory officials." For more information, read the 1 April 2010 Communique – Health Ministers Announce Approval of National Health Practitioner Registration Standards.

The latest documents sent for public consultation have been the Guidelines & Assessment Framework for the Recognition and Endorsement of Eligible Midwives from the Nursing and Midwifery Board of Australia and the National Guidance on collaborative Maternity Care from National Health and Medical Research Council.
The only way to have a voice is to be proactive and that means responding to these types of documents.....it is important to get as many people responding as possible because your comment count and helps to make new policies. The same applies to being politically active...this means lobbying your politicians for change.... At the end of the day it means that you need to spend some time writing about what you would like to see done.....it does take some effort on your part to create change.

Putting in submission is simple...it means you write what you would like to see changed about the policy and all submissions are published on the website and hopefully these comments are taken into consideration and some changes occur, that is if we are all on the same page for the change....for instance lets use one criteria from the Eligible midwife document.... the Board would like the 'eligible midwife' to have three years experience before they can practice independently.... in order to change this the submissions would have to all say 'where is the evidence for this criteria?' and that this is not acceptable because once you have finished your course as a midwife you are ready to practice as one.....you could argue that one year to gain experience as a graduate would be acceptable but not 3, or you could argue that once qualified you are ready to practice. The majority of comments would all have to say the same thing......However, you usually have to use a computer and email your response....but don't let that stop you....

I guess the proof will be in the pudding so to say..... when they release the next draft documents...... watch the blog or the websites to see when the submissions are published.... lets hope for the best.....

Who is the 'eligible midwife' - jumping through hoops

Well here it is the Nursing and Midwifery Board of Australia has released a draft of what 'eligible midwife' may look like.....

The Key points are as follows;
1. Current general registration as a midwife in Australia with no restrictions on practice - having as it does all the requirements for eligibility for registration under the Act.

2. Practice for at least three years across the continuum of midwifery care (ante-natal care, intrapartum care and post-partum care of women and their infants), within the previous 5 years.

3. participation in an additional 20 hours per year of continuing professional development relevant to the continuum of midwifery care.

4. successful completion of a NMBA approved professional midwifery practice review program for midwives working across the continuum of midwifery care.

5. compliance with the collaboration requirements for eligible midwives- that is the requirements for midwives to work collaboratively with other health professionals as outlined in regulation and national health policy instruments.

6. successful completion of an accredited and approved program of study determined by the Board to develop midwives' knowledge and skills in prescribing, or a program that is substantially equivalent to such an approved program of study (at midwifery post graduate level and designed around the flour components of prescribing - information gathering, clinical decision making, generation of medication order and monitoring the review.

As the model of care for eligible midwives is across the continuum of maternity care, eligibility is contingent upon all requirements being met..... therefore once a midwife has been endorsed as an eligible midwife; and authorised and provided with the necessary provider number by Medicare Australia: READ the full document Guidelines & Assessment framework for the recognition & endorsement of eligible midwives

2 Endorsement to practice as an eligible midwife (to read the full document click the hyperlink)

To be entitled to endorsement under section 98 of the National Law an applicant wishing to be identified as an eligible midwife must be able to meet all the requirements including being a currently registered midwife in Australia; being able to demonstrate through professional review of practice at least 3 years experience across the continuum of midwifery care within the 5 year period preceding the application, comply with the collaboration requirements for eligible midwives; and have an approved qualification to administer, obtain, possess, prescribe and supply scheduled medicines required for practice across that
continuum of midwifery care.

Wording to appear on the register
Endorsed as an eligible midwife working across the continuum of midwifery care and qualified to provide the associated services, order diagnostic investigations and administer, obtain, possess, prescribe and supply schedule 2,3,4 & 8 medicines in
accordance with relevant State and Territory legislation, required for midwifery practice.

If you wish to provide comments on this paper, please lodge a written submission in electronic form by email to natboards@dhs.vic.gov.au by close of business on Wednesday 27 April 2010.

My point of view is that a Midwife is a Midwife....and a Midwife should work across the continuum of maternity care....this in its self will make you an eligible midwife... but not according to the Government... we have to jump through all these hoops to be able to claim MBS & PBS..... in order to be a eligible midwife we have to be insured and complete everything stated above......

I will be putting in a submission to say that a midwife is a midwife once you have completed your course....no other country puts extra constraints on a midwife to make them so called 'eligible'..... if anything I could concede a year post registration... a graduate year before a midwife chooses to work in the community.... please anyone using maternity services can submit a comment to the NMBA... be proactive and have your say.....

lets see what transpires.......watch this space.......